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ICD Timing in New-onset DCM — EECC MCQ

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ModerateHeart FailureICD Timing in New-onset DCMEECC

A 55-year-old man with HFrEF (LVEF 25%) on optimal GDMT is referred for ICD implantation as primary prevention. He was diagnosed 2 months ago with new-onset non-ischaemic DCM. Is ICD implantation appropriate at this time?

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Correct answer: A — No — ICD implantation should be deferred until at least 3 months of optimal GDMT, as LVEF may recover sufficiently to no longer meet the indication (LVEF ≤35%)

The ESC 2022 VA/SCD Guidelines and 2023 HF Guidelines recommend a minimum of 3 months of optimal GDMT before reassessing LVEF for primary prevention ICD eligibility. This is because: (1) LVEF may recover significantly with GDMT (particularly in new-onset non-ischaemic DCM, where ~30-40% of patients show meaningful recovery); (2) ICD trials enrolled patients who had been on stable GDMT for ≥3 months; (3) the DANISH trial showed a less clear mortality benefit of ICD in non-ischaemic DCM compared with ischaemic CM. During the waiting period, a wearable cardioverter-defibrillator (WCD) may be considered for temporary protection in very high-risk patients.

Reference: ESC (2022): VA/SCD Guidelines; ESC (2023): HF Guidelines